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Two new studies have come out with the revelation that increasing the level of Quitline smoking cessation services and offering free nicotine patches are a successful and cost-effective way to reduce smoking rates.

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The studies were conducted by researchers at Kaiser Permanente's Center for Health Research in Portland, the Oregon Health Department, and Free & Clear in Seattle, a phone-based tobacco treatment program.

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The first study was led by Jeffrey Fellows, PhD and an investigator at Kaiser Permanente's CHR. It was found out in the study that when Oregon became the first state in the country to promote Quitline services by combining one 30-minute telephone counseling session with a free two-week supply of Nicotine Replacement Therapy using "earned" or unpaid media to increase calls from smokers, the number of callers to the Oregon Tobacco Quitline leaped from 6,426 to 13,646 annually, and their quit rates almost doubled.

Before taking this initiative, the Oregon Tobacco Quitline provided one 30-minute telephone counseling session with no NRT and promoted the service through paid advertising. Analysis of the one-year results showed that the free NRT initiative was extremely successful even after having costs higher than the costs of the pre-initiative program ($2.25 million versus $1.97 million)

This difference in costs of these two programmes was because the number of callers nearly doubled (from 6,428 to 13,646), quit rate nearly doubled (from 8.2 percent to 15.7 percent), number of quitters quadrupled (from 527 to 2142) and cost per quit fell more than $2,600 (from $3,778 to $1,050). "Cigarette smoking is the number one preventable cause of death and disease in this country, with more than 430,000 Americans dying from cigarette smoking every year. This study shows that offering free nicotine replacement therapy as part of Quitline counseling can dramatically increase the number of smokers who quit and reduce the average cost per quit,' said Jeffrey Fellows.

The second study was led by Jack Hollis, PhD and a senior investigator at Kaiser Permanente's CHR. It looked at 4,600 smokers and is the largest randomized trial ever conducted on the effectiveness and cost-effectiveness of alternative Quitline services and polices.

Smokers in the study were randomly assigned to one of six levels of services when they called the Oregon Tobacco Quitline: brief counseling (one 15-minute call) with or without NRT, moderate counseling (one 30-minute call and one follow-up call) with or without NRT, or intensive counseling (one 30-minute call and four follow-up calls) with or without NRT.

More than 21 percent of the smokers quit after receiving intensive counseling plus NRT, compared to 11.7 percent of the smokers who quit after brief counseling with no NRT. Successful quitting was defined as abstinence from all forms of tobacco for 30-plus days at the 12-month follow-up interview.

The study also found that satisfaction with Quitline services also increased with the more intense levels of service, rising to 92.5 percent satisfaction from 53.9 percent from those who just received brief counseling. Confirming expectations, costs per participant were higher for increased levels of service, ranging from $67 for brief counseling with no NRT to $268 for intensive counseling plus NRT.

The added costs of increased counseling and NRT were offset by their increased effectiveness, and all levels of service were highly cost-effective enhancements to brief counseling with no NRT. "Policymakers for state Quitlines might choose to offer only brief counseling with no NRT because the cost per caller is lower," said Jack Hollis.

He added: "However, our results suggest that higher quit rates, greater client satisfaction, and the potential to attract more smokers to Quitlines more than offset the modest additional costs. Heavily addicted smokers, who have the highest health care costs over time, may benefit even more from intensive counseling and medication."

"The state of Oregon has been a national leader in supporting research efforts to determine how best to use its Quitline to serve tobacco users. The unique partnership between the Oregon Health Department, Kaiser Permanente's Center for Health Research, and the Quitline service provider (Free & Clear) has resulted in major breakthroughs in our understanding of how nicotine patches and phone counseling can be provided to increase use of services and help people quit," said Tim McAfee, MD, MPH, a co-investigator on both studies.

The studies will be published in the December issue of Tobacco Control, a peer-reviewed publication of the British Medical Journal.

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